Top 5 Issues Surrounding Pain Management Billing For Medical Healthcare

 Chronic pain management has become a huge public health problem in the United States, costing society billions of dollars in missed time and productivity while significantly hurting people's lives.

These numbers will climb as the population ages and the incidence of long-term pain from arthritis or other age-related illnesses rises, and the pain medicine specialty will continue to grow. Pain management billing services are caught in the crossfire of increased prior authorization requirements, downward charge schedule revisions, and shifting financial responsibility, which are already being scrutinised by insurance payers.

Identifying The Top 5 Pain Management Coding Issues

A state-of-the-art revenue cycle management approach that includes sound coding and billing processes is more crucial than ever before in ensuring that your pain billing practice is paid for services in a timely and effective manner. Let's take a look at the top five coding mistakes made by pain medicine providers to ensure maximum reimbursement today and in the future:

1.       Prepare Appropriate Documentation for the Visit — With denials granted owing to missing information on a number of concerns, such as laterality or which nerves were treated, complete and accurate documentation is more crucial than ever in pain medicine. In the original surgical note or an amendment, pain medication practitioners must give detailed, accurate treatment information.

2.       Review Payer Policies and Guidelines to Make Sure Your Practice Is Up to Date — Recognizing that there are thousands of insurance companies, providers, and coders, it's critical to stay up to date on insurance payer policy changes in order to get the most money. To gather information from the enormous number of payers' updates and documents, detective work is sometimes required. This is crucial for eprescribing software.

3.       Recognize when fluoroscopy should be billed separately — Fluoroscopy is often billed separately from the treatment in many pain management practises. Make sure you know whether this is a bundled charge for the surgery you had, such as SI joint (27096), medial branch blocks, and facet injections, or if it's a separate price, such as fluoro guidance codes for peripheral joints.

4.       The Use of Modifiers is Critical to Reimbursement – Modifiers exist to clarify the service or operation performed, but they can cause denials or have a negative impact on revenue if they are missed or utilised inappropriately.

5.       Be Wary of Exceeding Permitted Procedure Number Limits – In pain management software, the number of operations performed must be carefully monitored in comparison to the number of approved visits allowed. Exceeding the permitted limit and having the visit(s) prohibited is extremely usual.

Avoiding anything that can cause a post-service prepayment coding review from insurance payers is critical to the success of any pain management coding and billing scheme. Insurance-mandated coding evaluations can delay payment by up to 180 days (or six months), wreaking havoc on the bottom line — and that's if you get paid at all.

Another option is to work with a third-party partner who not only knows how to code and bill efficiently, but also how to grow and keep up with the necessary training and updates to stay on top of things.

To learn more about how to improve your pain management billing workflow, contact us at Pain Management EHR.